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Tuberculosis of the greater trochanteric bursa occurring 51 years after tuberculous nephritis

T Yamamoto1, Y Iwasaki, M Kurosaka

  • 1Department of Orthopaedic Surgery, Kobe University School of Medicine, Kobe, Japan. yamatetu@med.kobe-u.ac.jp

Clinical Rheumatology
|September 12, 2002
PubMed

Insights

Tuberculosis can manifest in the hip bursa decades after initial infection, even after kidney tuberculosis has healed. Early diagnosis and surgical removal of the infected bursa with drug therapy offer a cure.

Area of Science:

  • Orthopedics
  • Infectious Diseases
  • Radiology

Background:

  • Tuberculosis (TB) can affect various organs, including musculoskeletal sites, often years after primary infection.
  • Greater trochanteric bursitis is a common cause of hip pain, typically associated with non-infectious etiologies.

Observation:

  • A 71-year-old man presented with chronic hip pain due to tuberculous greater trochanteric bursitis, 51 years after treated tuberculous nephritis.
  • Imaging revealed osteolysis of the greater trochanter, soft tissue calcification, and extensive bursal involvement extending into the femur.
  • Biopsy confirmed Mycobacterium tuberculosis infection of the bursa.

Findings:

  • Surgical excision of the infected bursa combined with antituberculous therapy resulted in a complete cure.
  • This case highlights the potential for late reactivation of tuberculosis in musculoskeletal tissues.

Implications:

  • Tuberculous greater trochanteric bursitis should be considered in the differential diagnosis of chronic hip pain, especially in patients with a history of TB.
  • Musculoskeletal tuberculosis can present with delayed-onset lesions, emphasizing the importance of long-term surveillance after primary TB treatment.
  • This case underscores the diverse clinical presentations and potential for dormant Mycobacterium tuberculosis reactivation.

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